<p begin="00:00:00.000" end="00:00:02.167">(silence)</p>

<p begin="00:00:07.746" end="00:00:09.338" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.338" end="00:00:11.582" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.582" end="00:00:13.980" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.980" end="00:00:17.703" style="s2">of the metatarsal phalangeal<br />joint in the foot.</p>
<p begin="00:00:17.703" end="00:00:20.014" style="s2">The patient is placed<br />in a supine position,</p>
<p begin="00:00:20.014" end="00:00:23.285" style="s2">with the knee flexed<br />and the foot on the bed.</p>
<p begin="00:00:23.285" end="00:00:25.927" style="s2">The transducer is placed<br />over the dorsal surface</p>
<p begin="00:00:25.927" end="00:00:28.017" style="s2">of the metatarsal phalangeal joint</p>
<p begin="00:00:28.017" end="00:00:29.924" style="s2">in a longitudinal fashion,</p>
<p begin="00:00:29.924" end="00:00:31.557" style="s2">with the orientation marker directed</p>
<p begin="00:00:31.557" end="00:00:33.545" style="s2">toward the patient's head.</p>
<p begin="00:00:33.545" end="00:00:35.281" style="s2">The metatarsal head is seen</p>
<p begin="00:00:35.281" end="00:00:38.347" style="s2">as a bright, hyperechoic<br />rounded structure.</p>
<p begin="00:00:38.347" end="00:00:40.487" style="s2">The proximal phalanx can be seen</p>
<p begin="00:00:40.487" end="00:00:42.940" style="s2">as a hyperechoic linear structure,</p>
<p begin="00:00:42.940" end="00:00:45.201" style="s2">just distal to the metatarsal.</p>
<p begin="00:00:45.201" end="00:00:48.264" style="s2">The extensor tendon lies<br />above the bony structures,</p>
<p begin="00:00:48.264" end="00:00:52.106" style="s2">and appears as a hyperechoic<br />fibrillar structure.</p>
<p begin="00:00:52.106" end="00:00:54.796" style="s2">The metatarsal phalangeal<br />joint can be seen</p>
<p begin="00:00:54.796" end="00:00:58.425" style="s2">as a dark hypoechoic region<br />between the metatarsal head</p>
<p begin="00:00:58.425" end="00:01:00.351" style="s2">and the first phalanx.</p>
<p begin="00:01:00.351" end="00:01:02.273" style="s2">The transducer should be slowly moved</p>
<p begin="00:01:02.273" end="00:01:05.612" style="s2">along the medial surface of<br />the metatarsal phalangeal joint</p>
<p begin="00:01:05.612" end="00:01:08.060" style="s2">to evaluate the joint space.</p>
<p begin="00:01:08.060" end="00:01:12.012" style="s2">The transducer is rotated<br />90 degrees counterclockwise</p>
<p begin="00:01:12.012" end="00:01:14.154" style="s2">to obtain a transverse view.</p>
<p begin="00:01:14.154" end="00:01:17.288" style="s2">The extensor tendon appears<br />as an elliptical structure</p>
<p begin="00:01:17.288" end="00:01:19.455" style="s2">above the metatarsal head.</p>
<p begin="00:01:19.455" end="00:01:21.400" style="s2">The transducer should be slowly moved</p>
<p begin="00:01:21.400" end="00:01:25.567" style="s2">to allow a full view of the<br />metatarsal phalangeal joint.</p>

<p begin="00:00:06.926" end="00:00:09.606" style="s2">- [Voiceover] Ultrasound has literally</p>
<p begin="00:00:09.606" end="00:00:11.057" style="s2">transformed my practice.</p>
<p begin="00:00:11.057" end="00:00:14.333" style="s2">I can get closer to the<br />diagnosis, which is so important</p>
<p begin="00:00:14.333" end="00:00:16.843" style="s2">figuring out what treatment you can do</p>
<p begin="00:00:16.843" end="00:00:18.979" style="s2">to keep people active,<br />to keep people doing</p>
<p begin="00:00:18.979" end="00:00:21.314" style="s2">what they wanna do, it<br />makes me a better doctor,</p>
<p begin="00:00:21.314" end="00:00:24.569" style="s2">and patients are better off because of it.</p>
<p begin="00:00:24.569" end="00:00:26.415" style="s2">I'm Kimberly Harmon, I'm a Team Physician</p>
<p begin="00:00:26.415" end="00:00:28.051" style="s2">at the University of Washington.</p>
<p begin="00:00:28.051" end="00:00:30.548" style="s2">I'm also the Director of the<br />Sports Medicine Fellowship here</p>
<p begin="00:00:30.548" end="00:00:33.704" style="s2">and so we train people who<br />have finished their Family</p>
<p begin="00:00:33.704" end="00:00:38.312" style="s2">Medicine residencies, to<br />be Sports Medicine doctors.</p>
<p begin="00:00:38.312" end="00:00:41.887" style="s2">Down in the athletic training<br />room, on practice days</p>
<p begin="00:00:41.887" end="00:00:43.396" style="s2">it can be a slower paced environment,</p>
<p begin="00:00:43.396" end="00:00:45.431" style="s2">but it also depends what's coming up.</p>
<p begin="00:00:45.431" end="00:00:47.866" style="s2">So if there's an important<br />game or competition</p>
<p begin="00:00:47.866" end="00:00:50.481" style="s2">that's coming up, the sort<br />of urgency in terms of</p>
<p begin="00:00:50.481" end="00:00:53.915" style="s2">getting somebody back to<br />play, definitely increases.</p>
<p begin="00:00:53.915" end="00:00:56.993" style="s2">The more information you<br />can have about a situation</p>
<p begin="00:00:56.993" end="00:01:00.676" style="s2">makes it easier to put people<br />back in or to hold them,</p>
<p begin="00:01:00.676" end="00:01:02.777" style="s2">so for instance if you know<br />if something is fractured,</p>
<p begin="00:01:02.777" end="00:01:06.508" style="s2">versus if it's just<br />bruised, that's a different</p>
<p begin="00:01:06.508" end="00:01:07.965" style="s2">set of decision making.</p>
<p begin="00:01:07.965" end="00:01:10.266" style="s2">The real, sort of<br />difference maker in terms of</p>
<p begin="00:01:10.266" end="00:01:13.124" style="s2">it being such an important<br />piece of equipment</p>
<p begin="00:01:13.124" end="00:01:16.422" style="s2">was when we had our star<br />player, who went down</p>
<p begin="00:01:16.422" end="00:01:19.578" style="s2">and he had a contusion to his quad.</p>
<p begin="00:01:19.578" end="00:01:21.709" style="s2">By Tuesday, the week before our game,</p>
<p begin="00:01:21.709" end="00:01:25.052" style="s2">he wasn't any better,<br />and in fact it was unsure</p>
<p begin="00:01:25.052" end="00:01:27.009" style="s2">whether he could practice that day.</p>
<p begin="00:01:27.009" end="00:01:29.149" style="s2">- I didn't know what we're<br />gonna do, honestly, you know.</p>
<p begin="00:01:29.149" end="00:01:30.580" style="s2">It was kind of getting to the point where</p>
<p begin="00:01:30.580" end="00:01:32.405" style="s2">it didn't look like he was<br />gonna be able to participate</p>
<p begin="00:01:32.405" end="00:01:35.164" style="s2">at a very high level, and<br />it was when we were first</p>
<p begin="00:01:35.164" end="00:01:36.703" style="s2">sort of testing out the ultrasound,</p>
<p begin="00:01:36.703" end="00:01:38.390" style="s2">and first getting used to that technology,</p>
<p begin="00:01:38.390" end="00:01:40.868" style="s2">and Doctor Harmon was like,<br />well let's check it out</p>
<p begin="00:01:40.868" end="00:01:42.652" style="s2">in the ultrasound, let's<br />see what we can see.</p>
<p begin="00:01:42.652" end="00:01:45.815" style="s2">- I put the ultrasound on<br />him, we saw this big hematoma,</p>
<p begin="00:01:45.815" end="00:01:49.144" style="s2">this big collection of blood<br />in the middle of his quad,</p>
<p begin="00:01:49.144" end="00:01:50.798" style="s2">his thigh muscle, and we were like,</p>
<p begin="00:01:50.798" end="00:01:54.605" style="s2">well there's your problem, and so just,</p>
<p begin="00:01:54.605" end="00:01:58.105" style="s2">grabbed a needle, and drained about 85 cc.</p>
<p begin="00:02:00.008" end="00:02:02.637" style="s2">- And that day he felt 100% better.</p>
<p begin="00:02:02.637" end="00:02:04.224" style="s2">He was able to run around without a limp,</p>
<p begin="00:02:04.224" end="00:02:06.342" style="s2">he felt fine, you know<br />it was just a matter of</p>
<p begin="00:02:06.342" end="00:02:07.893" style="s2">the traditional methods we were using,</p>
<p begin="00:02:07.893" end="00:02:10.098" style="s2">we couldn't get that fluid<br />out of there fast enough.</p>
<p begin="00:02:10.098" end="00:02:11.389" style="s2">And I don't know if he could've played</p>
<p begin="00:02:11.389" end="00:02:13.663" style="s2">if it wasn't for her<br />stepping in and saying,</p>
<p begin="00:02:13.663" end="00:02:16.043" style="s2">hey let's try this out, let's<br />try this technology out.</p>
<p begin="00:02:16.043" end="00:02:18.161" style="s2">- This was really a difference maker</p>
<p begin="00:02:18.161" end="00:02:20.453" style="s2">in terms of getting this<br />player back to play.</p>
<p begin="00:02:20.453" end="00:02:21.881" style="s2">I think that it's going to become</p>
<p begin="00:02:21.881" end="00:02:23.807" style="s2">an integral part of the way we practice</p>
<p begin="00:02:23.807" end="00:02:26.125" style="s2">Musculoskeletal Medicine<br />and Sports Medicine.</p>
<p begin="00:02:26.125" end="00:02:29.926" style="s2">It's made a huge impact in<br />my practice, my patients'</p>
<p begin="00:02:29.926" end="00:02:34.093" style="s2">satisfaction, left less people<br />out for advanced imaging.</p>
<p begin="00:02:34.993" end="00:02:36.737" style="s2">- [Rob] There's no reason<br />why every university</p>
<p begin="00:02:36.737" end="00:02:38.187" style="s2">in the entire country shouldn't have</p>
<p begin="00:02:38.187" end="00:02:39.467" style="s2">ultrasound in their training room.</p>
<p begin="00:02:39.467" end="00:02:41.876" style="s2">It's affordable, it's extremely useful,</p>
<p begin="00:02:41.876" end="00:02:43.816" style="s2">it allows us to do our job better.</p>
<p begin="00:02:43.816" end="00:02:45.412" style="s2">I can't imagine going back now.</p>
<p begin="00:02:45.412" end="00:02:47.539" style="s2">Having access to diagnostic ultrasound</p>
<p begin="00:02:47.539" end="00:02:49.291" style="s2">in the training room<br />for the past two years,</p>
<p begin="00:02:49.291" end="00:02:52.269" style="s2">I can't imagine trying to<br />go back to work without one.</p>
<p begin="00:02:52.269" end="00:02:53.823" style="s2">- Medicine has maybe gone for more</p>
<p begin="00:02:53.823" end="00:02:55.936" style="s2">paternalistic sort of delivery where me</p>
<p begin="00:02:55.936" end="00:02:57.801" style="s2">telling you what you have<br />and you saying okay doc,</p>
<p begin="00:02:57.801" end="00:03:00.593" style="s2">and going and doing whatever to more of a</p>
<p begin="00:03:00.593" end="00:03:02.878" style="s2">partnership in care, and<br />you need to sort of buy-in</p>
<p begin="00:03:02.878" end="00:03:04.361" style="s2">to what I'm telling you in terms of</p>
<p begin="00:03:04.361" end="00:03:06.053" style="s2">that you're making the correct diagnosis</p>
<p begin="00:03:06.053" end="00:03:07.990" style="s2">and you've got the correct treatment plan,</p>
<p begin="00:03:07.990" end="00:03:09.978" style="s2">and that you've really got<br />their best interests in mind</p>
<p begin="00:03:09.978" end="00:03:12.459" style="s2">and that you move forward with that.</p>
<p begin="00:03:12.459" end="00:03:16.072" style="s2">I've never gotten hugged by<br />more patients in all my life.</p>
<p begin="00:03:16.072" end="00:03:17.785" style="s2">When people get better,<br />particularly when they're</p>
<p begin="00:03:17.785" end="00:03:20.658" style="s2">not expecting to get better,<br />they're really appreciative,</p>
<p begin="00:03:20.658" end="00:03:23.241" style="s2">and it's a really good feeling.</p>

<p begin="00:00:00.140" end="00:00:02.982" style="s2">(gentle music)</p>
<p begin="00:00:02.982" end="00:00:05.705" style="s2">- [Voiceover] At the<br />2011 NBA draft combine,</p>
<p begin="00:00:05.705" end="00:00:07.593" style="s2">some of the top basketball prospects</p>
<p begin="00:00:07.593" end="00:00:09.874" style="s2">were in Chicago for some intense training,</p>
<p begin="00:00:09.874" end="00:00:12.897" style="s2">as they prepared for the 2011 NBA draft.</p>
<p begin="00:00:12.897" end="00:00:15.147" style="s2">NBA team physicians were there as well,</p>
<p begin="00:00:15.147" end="00:00:17.411" style="s2">and they received some<br />training of their own,</p>
<p begin="00:00:17.411" end="00:00:18.781" style="s2">thanks to Sonosite.</p>
<p begin="00:00:18.781" end="00:00:21.654" style="s2">The preferred ultrasound<br />provider of the NBA.</p>
<p begin="00:00:21.654" end="00:00:24.266" style="s2">- Ultrasound machines used to be large,</p>
<p begin="00:00:24.266" end="00:00:26.155" style="s2">the size of a dishwasher.</p>
<p begin="00:00:26.155" end="00:00:29.905" style="s2">Sonosite really has been<br />the technological leader</p>
<p begin="00:00:29.905" end="00:00:32.267" style="s2">in miniaturizing this really valuable</p>
<p begin="00:00:32.267" end="00:00:34.374" style="s2">piece of equipment so that it's portable.</p>
<p begin="00:00:34.374" end="00:00:37.584" style="s2">- I know when the players are watching</p>
<p begin="00:00:37.584" end="00:00:41.163" style="s2">our team orthopedists perform<br />ultrasound techniques,</p>
<p begin="00:00:41.163" end="00:00:42.460" style="s2">they're very interested<br />cause it gives them</p>
<p begin="00:00:42.460" end="00:00:43.922" style="s2">real time feedback.</p>
<p begin="00:00:43.922" end="00:00:46.145" style="s2">- [Voiceover] Under the direction<br />of Doctor Alan Hirahara,</p>
<p begin="00:00:46.145" end="00:00:49.551" style="s2">one of the thought leaders in<br />orthopedic sports medicine,</p>
<p begin="00:00:49.551" end="00:00:51.397" style="s2">the NBA team physicians were trained</p>
<p begin="00:00:51.397" end="00:00:55.162" style="s2">in some of the many uses of<br />musculoskeletal ultrasound.</p>
<p begin="00:00:55.162" end="00:00:57.631" style="s2">- They get to be able to<br />see their own problems,</p>
<p begin="00:00:57.631" end="00:01:00.349" style="s2">their own pathologies, their own tears,</p>
<p begin="00:01:00.349" end="00:01:03.136" style="s2">they get to see the injection<br />itself when they get one</p>
<p begin="00:01:03.136" end="00:01:04.307" style="s2">so that there's no question,</p>
<p begin="00:01:04.307" end="00:01:06.098" style="s2">they know that what I just did,</p>
<p begin="00:01:06.098" end="00:01:07.773" style="s2">it went where it was supposed to go.</p>
<p begin="00:01:07.773" end="00:01:09.850" style="s2">- This ultrasound machine allows us to</p>
<p begin="00:01:09.850" end="00:01:12.306" style="s2">evaluate people immediately.</p>
<p begin="00:01:12.306" end="00:01:13.889" style="s2">- So we can get them back to play,</p>
<p begin="00:01:13.889" end="00:01:16.037" style="s2">get them back to training sooner.</p>
<p begin="00:01:16.037" end="00:01:19.170" style="s2">- I believe the Sonosite<br />portable ultrasound product</p>
<p begin="00:01:19.170" end="00:01:21.685" style="s2">really represents the<br />cutting edge of healthcare.</p>
<p begin="00:01:21.685" end="00:01:23.491" style="s2">- [Doctor Hirahara] There's<br />no question that this helps</p>
<p begin="00:01:23.491" end="00:01:26.294" style="s2">us evaluate them and<br />evaluate their injuries</p>
<p begin="00:01:26.294" end="00:01:27.889" style="s2">and their status.</p>
<p begin="00:01:27.889" end="00:01:30.067" style="s2">- I have every belief that this represents</p>
<p begin="00:01:30.067" end="00:01:32.388" style="s2">where we're going and what the future</p>
<p begin="00:01:32.388" end="00:01:35.500" style="s2">of sports medicine is<br />from a medical standpoint.</p>
<p begin="00:01:35.500" end="00:01:38.083" style="s2">(gentle music)</p>